2/6/2019. Disclaimer. Electronic Nicotine Delivery Systems (ENDS) How Much Do You Know About Vaping?

Transcription

1 How Much Do You Know About Vaping? Larry N Williams, DDS, MPH Associate Professor, Midwestern University College of Dental Medicine-Illinois Special thanks to Kirk W. Noraian, D.D.S., M.S. Disclaimer The findings and conclusions of this presentation are those of the author Any mention of trade names or products are for scientific purposes and are not meant as an endorsement Neither I nor members of my immediate family have any financial relationships with commercial entities that may be relevant to this presentation. Electronic Nicotine Delivery Systems (ENDS) E-Pipe E-cigar E-Cigarette 1

2 For over 100 years, smoking technology did not change But public opinion of smoking did. Then Tobacco companies were faced with fewer people using cigarettes and with resulting sales decrease (nearly ½ million tobacco users die each year) Tobacco companies looked to continue their profits with new products such as snus, chew, dip, and The electronic nicotine delivery system (ENDS) Vaping was born 2

3 The re-invention of smoking 1963 Herbert A. Gilbert First U.S. Patent 2003 Hon Lik, Pharmacist invents first e- cigarette 2006 First e-cigarettes come to US & Europe Now we see the new face of smoking. Where s the Marlboro man? At least 4 of them died from their tobacco use So what is Vaping? A means to the ends ENDS is used to deliver nicotine liquid that is vaporized Vape pens E-hookahs Hookah pens Smoke Free Technology 3

4 Can you say Juul? Hot on the market Easily hidden by students Terminology Vaper Someone who uses e-cigarettes Vapor Plume Aerosol Fog International Growth in E-cig Usage $2 Billion in sales in US Will bypass cigarettes by 2024 As of January, e-cig brands 7,764 unique flavors Banned in Brazil Norway Singapore Restricted sales to minors? In 2010, WHO wanted a ban on promoting healthy benefits of e-cigs By 2017, EU recognized e-cigs as medical devices (Still Pending) 4

5 To Smoke or Vape? 52% of current smokers have tried e- cigarettes Smokers who vape % % % Greatest increase is among men Influenced by parent and peer use Some vape, some smoke and some vape & smoke Child and adolescent problem Among middle and high school students, 3.62 million were current users of e-cigarettes in E-cigarette use, from 2017 to 2018, increased 78 percent among high school students (11.7% to 20.8%) and 48 percent among middle school students (3.3% to 4.9%) from 2017 to According to a survey, 81 percent of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use htm Perceived Benefits of Vaping among Vapers No tar No smoke smell Elimination of chemicals/carcinogens Fewer restrictions 70% less expensive than cigarettes **Disclaimer Consult your physician Make your own conclusion 5

6 Pick your poison Batteries & Hardware Basics Battery size matters Advanced Variable voltage Larger reservoirs Cartomizers (small) Clearomizers (medium) Tanks (Large) Charger Battery Safety Always Use the Charger Specifically Designed for Your Battery Never Leave a Charging Battery Unattended Immediately Remove Your Battery From the Charger Once It s Fully Charged Keep Separate Batteries Away From Each Other and Protected From Metal Make Sure Your Batteries Are Rated for the Coil of Your Atomizer Keep Your Batteries Out of the Extreme Heat From onvaping.com 6

7 E-Liquid Safety Keep in a Cool Dark Place away from Children & Pets If You Find Your Child or Pet Covered in E Juice or They're Near an Empty E juice Bottle Call the Poison Control Center Right Away From onvaping.com E-Liquid Safety If You Get E Juice on Your Body, Wash It off ASAP Fatal immediate adult dose of nicotine (50-60mg) Less for kids 10% may be lethal to your pets If You Find Yourself Chain-Vaping, Use a Lower Nicotine Concentration If You Have a Propylene Glycol (PG) Sensitivity Use 100% Vegetable Glycerin (VG) E Juice From onvaping.com E-liquid PG propylene glycol Aircraft de-icing fluid RV/Marine anti-freeze Dogfood Banned by FDA in cat food Heinz Body Anemia Irreversible Hgb damage VG vegetable glycerin 13 Week Rat Study Flavoring Nicotine Preservatives Over 5,000 flavors 7

8 FDA ENDS mission In 2016, FDA finalized a rule extending regulatory authority to cover all tobacco products, including electronic nicotine delivery systems (ENDS) that meet the definition of a tobacco product. FDA now regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS, including components and parts of ENDS but excluding accessories. FDA rule on Addictiveness Required Nicotine Addictiveness Warning on Packages and Advertisements Beginning in 2018, all newly-regulated "covered" tobacco products* must bear the required nicotine addictiveness warning statement on product packages and advertisements. *Note: Cigars also have additional required warning statements. More FDA action on ENDS FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of ENDS, including components and parts of ENDS but excluding accessories. 8

9 More FDA action on ENDS If you make, modify, mix, manufacture, fabricate, assemble, process, label, repack, relabel, or import ENDS, you must comply with the requirements for manufacturers. Beginning in 2018, all "covered" tobacco products* must bear the required nicotine addictiveness warning statement on product packages and advertisements. *Note: Cigars, which are also covered tobacco products, have additional required warning statements. If you sell ENDS, e-liquids, or their components or parts made or derived from tobacco, retailers must follow new rules. More FDA action on ENDS If you operate a vape shop that mixes or prepares liquid nicotine or nicotine-containing e-liquids, or creates or modifies any type of ENDS, you may be considered a manufacturer. Tobacco products imported or offered for import into the United States must comply with all the applicable requirements under the Federal Food, Drug, and Cosmetic Act (FD&C Act). If you have experienced an unexpected health or safety issue with a specific tobacco product, you can report a problem with any tobacco product, including vapes, to the FDA. Knowledge about adverse experiences can help the FDA identify health or safety issues beyond those normally associated with product use. 9

10 More Positives of E-cigs Characteristics E-cigarettes Conventional Cigarettes Health risks Respiratory illness/asthma Middle ear disease SIDS \ > Less risk / \ > More risk / Exposure to vapors Less toxic Initiate cytoxicity Initiate pro-inflammatory profile In-vitro studies (e-liquids, aerosols) Particle matter levels No meaningful toxic effects Lower with nicotine As well as nicotine free e- cigs Cytotoxic Genotoxic Greater Aerosols created Fewer 1500X more harmful components Secondary smoke Less risk Much greater risk Negatives of E-cigs Characteristics E-cigs Conventional Cigarettes Main disadvantage Human health Environmental health Human health Environmental health Exhaled particle matter 25X greater than urban air Greater than e-cigs Respiratory system (nonsmoker) 5minute test of E-cig w/nicotine 25-35X particle dose in nonsmokers Greater Increased total resp. impedance Increased peripheral airway resistance Increased oxidative stress Cytotoxic effects Related to flavoring compounds Well-known Ingredients Not fully disclosed Improper labelling Variability between/within brands Inconsistent nicotine content Nicotine free may have nicotine Not fully disclosed Key fact One ENDS refill pod is equal to the nicotine in one pack of cigarettes Highly addictive 10

11 No amount of nicotine is known to be safe to take during pregnancy. - There is a direct association between maternal smoking and SIDS. - Nicotine accentuates neurotransmitter function in adults but desensitizes these functions in prenatally exposed infants and children. Chemicals from Heating Vaping Liquid Formaldehyde Byproduct of some e-cigarettes Probable carcinogen Created by heat at high voltages Glyoxal Formaldehyde releaser found in 20% of cosmetics Acetaldehyde Another probable carcinogen Diacetyl Popcorn lung scleroses lung air sacs Acrolein From heated glycerin Damages lungs Contributes to heart disease in smokers Sn, Ni, Cr Line pulmonary alveoli inhaled from heating element Nitric Oxide Potential cardiovascular toxicity Periodontal Implication In vitro study of menthol additives, Harmful effect on human periodontal ligament fibroblast proliferation. Willershausen, I, et al. Influence of E-smoking liquids on human periodontal ligament fibroblasts. Head Face Med. 2014; 10:39. 11

12 What is the most prevalent oral health condition that dentists are seeing among patients who vape? The most prevalent issue is the unknown. The electronic vaping products are now being tested with some preliminary data showing the vaping products cause inflammation to the gingiva (gums) and the potential for delayed healing. We must remember that the harmful effects of smoked tobacco were not known until decades of use and many cases of cardiovascular and respiratory disease. With preliminary studies showing some deleterious effects of vaping on oral tissues, it will take time to see what the long term effects will be. The question arises- Do we allow use until we definitively know? Or do we allow use until studies are published. Findings from new research E-Cigarettes Can Leak Toxic Metals Into Vapers Lungs, Study Suggests. USA Today (2/23, May) reported that researchers at Johns Hopkins Bloomberg School of Public Health found significant levels of highly toxic arsenic and other potentially harmful metals in e-cigarette vapors, according to a study in Environmental Health Perspectives. The study s samples also contained significant levels of chromium, manganese, nickel, and lead. Study senior author Ana María Rule, assistant scientist in the Bloomberg School s Department of Environmental Health and Engineering, said, It s important for the FDA, the e-cigarette companies and Vapers themselves to know that these heating coils, as currently made, seem to be leaking toxic metals which then get into the aerosols that Vapers inhale. Fox News (2/23, Dadourian) reported the research team tested liquids in the refilling dispensers from 56 Baltimore area vaping stores and found potentially unsafe levels of arsenic, chromium, manganese, nickel and lead. The results also showed that aerosol metal concentrations were highest for e-cigarettes with more frequently changed coils. Fox News points out that the FDA has the authority to regulate e-cigarettes, but has not issued any rulings on the matter so far. U.S. News & World Report (2/23, Lardieri) reported, Researchers are hopeful results of studies showing the harmful levels of toxic metals in e-cigarettes will help the FDA create rules to govern the devices. The ADA Foundation offers a resource on e-cigarettes. February 27, 2018 The Face of E-cigarette Explosions It lit my kids face on fire. - Alberta, Canada - 1/27/17 School Counselor loses an eye. Orange County, CA April,

13 Almost paralyzed while on smoke break at work Colorado Springs, CO 11/25/15 E-cig acts like a flair in man s pocket. San Diego, CA February, 2016 In coma, after e-cig explosion and becomes a projectile down his throat. - Destin, FL - 9/8/15 Texas man dies from e-cigarette (CNN)A Texas man died of a massive stroke after the e- cigarette he was using exploded and tore his carotid artery. The Tarrant County Medical Examiner's office says that William Brown died in a Fort Worth hospital on January just weeks shy of his 25th birthday. The death certificate says he died from cerebral infarction and herniation after debris from the exploding vape pen dissected his left carotid artery. There were 195 separate e-cigarette fire and explosion incidents in the United States reported by the media between 2009 and 2016, according to a report by the US Fire Administration. 13

14 New Technology New Experiments Websites cropping up How to make your own brews Methamphetamines? Heroin? Crack cocaine? Prescription medications? Nicotine primes human brains to respond to cocaine Dr. Denise Kandel - Columbia University Medical Center 2004 Epidemiologic Data Cites special risks to developing brains Adolescents Nicotine rewires the brain Levine, A.; Huang, Y.; Drisaldi, B.; Griffin, E.A. Jr.; Pollak, D.D.; Xu, S.; Yin, D.; Schaffran, C.; Kandel, D.B.; Kandel, E.R.. Molecular mechanism for a gateway drug: Epigenetic changes initiated by nicotine prime gene expression by cocaine, Science Translational Medicine 02 Nov 2011: Vol. 3, Issue 107, pp. 107ra109 Illicit Drug Use in E-cigarettes Liquid THC (Tetrahydrocannabinol) Main psychoactive substance in marijuana Person gets high Without odor Appears to inhaling legal nicotine Teens have discovered this vehicle for pot Parents - more vigilant for intoxication Blood-shot eyes Loud speech Improper laughter Loss in motivation Weight gain 14

15 Resources for more information FDA gredientscomponents/ucm htm CDC American Lung Association health.html Questions? 15